GP locum insurance and indemnity — what state-backed cover does and doesn't include

Since April 2019, GPs in England have had state-backed indemnity for NHS work, and a lot of locums concluded that indemnity was now someone else’s problem.

It isn’t quite that simple. The state-backed scheme is a big help, but it has limits, and the limits are exactly where locums can find themselves exposed. Here’s how it works, where the gaps are, and what else is worth considering.

The basics: indemnity vs insurance

• Indemnity from a medical defence organisation (MDO) is traditionally discretionary: the MDO decides whether to help with a claim, based on its rules.
• Insurance is a contract: if the claim falls within the policy, the insurer pays.

For practical purposes, the question isn’t which word is on the paperwork. It’s what exactly is covered, for which type of work, and what happens after I stop working or change provider. Ask about that last point in particular.

The GMC expects every doctor to have adequate and appropriate cover for their practice, so this isn’t optional.

England: the Clinical Negligence Scheme for General Practice (CNSGP)

CNSGP covers clinical negligence liabilities arising from NHS primary care work under GP contracts in England, for incidents on or after 1 April 2019. For locums:

• Your employment status doesn’t decide whether you’re covered. Locums who aren’t employed by a practice but are engaged by it to carry out covered activities are generally covered for those activities.
• Cover attaches to the activity you’re carrying out for the NHS provider, not to you as a person.

That’s good news, and it means many locums no longer need to pay for the same cover twice. But look at what it doesn’t include.

What CNSGP typically does not cover

Official and professional guidance consistently says you need separate cover for activities and services outside the scheme. In practice that includes:

• Private work. Private GP consultations, insurance and occupational health medicals, medicolegal reports, cosmetic work and any other work outside an NHS contract.
• Legal and regulatory costs. Support if you face a GMC investigation or fitness-to-practise proceedings, which are not covered by a clinical negligence scheme.
• Other proceedings and advice, such as inquests, complaints and disciplinary matters, and legal advice for non-clinical issues. Check exactly what your MDO includes.
• Work outside England’s GP contract framework. Check the position for your type of work, such as out-of-hours, urgent care or hospital settings, because it depends on how the service is contracted.

If you do any private work at all, even occasionally, you need cover for it.

The rest of the UK

Arrangements differ between the four nations, so don’t assume the English rules apply.

• Wales. State-backed cover is provided through the General Medical Practice Indemnity scheme, and as a locum you need to be on the All Wales Locum Register to benefit.
• Scotland and Northern Ireland. GMC guidance says locum GPs there need to arrange their own adequate and appropriate indemnity or insurance, because the English and Welsh schemes don’t apply.

If you work across borders, confirm the position with your MDO or insurer for each setting.

Why many locums still keep MDO membership

Even where the state scheme covers your NHS clinical negligence, many locums stay with an MDO or insurer because it provides:

• Support with GMC and regulatory matters
• Advice and a helpline when things go wrong
• Cover for private and other non-NHS work
• Continuity of cover and a safety net where there’s any doubt about whether something falls within the state scheme

It’s worth asking your provider what they actually offer for a locum who works only in NHS general practice, since some have products designed for this.

Questions to ask any provider

1. What am I covered for, and what is excluded?
2. Does this cover private work, and are there limits?
3. Do I get legal and regulatory support (for example GMC)?
4. What happens to my cover if I stop working, retire or move abroad?
5. How is the price set, and what causes it to change?
6. How do you treat work in each UK nation I may work in?
7. Is the cover discretionary or contractual?

Other insurance worth thinking about

Locum doctors don’t get sick pay, holiday pay or a salary during a long illness. Consider:

• Income protection. Pays a proportion of your income if illness or injury stops you working. Read the definition of “unable to work” carefully, because some policies are stricter than others.
• Life and critical illness cover, especially if others depend on your income.
• Personal accident or health cover, if it suits your situation.
• Public liability or equipment cover, if you work with your own equipment or run any business activity.
• Car insurance with business use, because you’ll be driving to a different site most days. Check that your policy covers travel between work locations, since commuting-only cover may not be enough.

Tax and records

In general, indemnity and insurance subscriptions that relate to your work as a self-employed locum are a business expense, and they appear in your Self Assessment. The treatment of other policies, such as personal income protection, depends on the type of policy, so ask your accountant.

This is general information, not personal insurance, legal, financial or tax advice. The extent of your cover depends on your circumstances and your provider’s terms, so check with NHS Resolution, your MDO or insurer, and a qualified adviser before making decisions.